Individual
PORSCHE PIGGIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LIMITED LICENSE PSY
Contact information
Practice address
13101 ALLEN RD, SOUTHGATE, MI 48195-2216
(734) 785-7705
Mailing address
7264 CANTERBURY DR, ROMULUS, MI 48174-6327
(734) 288-6494
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6362009602
MI
103TM1800X
Intellectual & Developmental Disabilities Psychologist
6362009602
MI
Other
Enumeration date
09/26/2022
Last updated
09/26/2022
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